Some men have queer ideas of science. Something was said about young men who were taken into an office until they could polish plates, and on a certificate to that effect, enter college. I tell you if a young man can make a first-class polish on a gold plate he knows the science of it. He has done it, and he knows how it is done.

The proportion of thoroughly educated men in medicine and in dentistry is largely in favor of dentistry. I may say ten to one, in proportion to the number engaged in the two professions. It is not what a man knows when he goes into the college, that makes him what he is, but what he knows when he comes out.

As a rule, any office-teaching we get to-day from the average dentist, is a disadvantage. I would rather take a young man from behind the plough. It is a mistake to think that office training fits a young man for the dental college; it is wrong to the very core. Neither do I see the necessity of teaching all the branches of medical science, to make a man a practical dentist. What use has he for midwifery or pharmacy? of how to treat yellow fever or cholera? When he comes to practice dentistry he will have no use for it. If there is a case of cholera in the neighborhood, he will want to get away from it. Let him prepare himself for dentistry, on a broad foundation, but lay aside all collateral branches. The respectability or the disgrace of dentistry rests on your shoulders.-Southern Dental Journal

ARTICLE II.

PYORRHOEA ALVEOLARIS.

BY ALFRED R. STARR, M. D., D. D. S.

Pyorrhoea Alveolaris, sometimes called Rigg's disease, catarrhal or suppurative gingivitus or ulitis, and alveolar pyorrhoea, is a disease of which much has been written, but

as yet little is known. It is described by some as a disease characterized by a flow of pus from the tooth sockets. The effect upon the gums and alveoli differs very materially from the usual results of salivary calculus, in that in this disease the ulcerative process or retrograde metamorphosis is most marked in the pericementum and alveclus, while the gums are comparatively free. In this affection the destruction and separation of the pericementum and the absorption of the alveoli are greater and more rapid than the recession of the gums, thus resulting in the formation of deep pockets between the gums and the teeth, from which pockets exudes an ichorous or sanious discharge, In cases of salivary calculus proper, with no secondary sanguinary deposit, the recession of the gums, destruction of the pericementam and absorption of the alveolus occur slowly, and the process is limited to the immediate vicinity of the deposit; so that if we go a little beyond the point of contact of the deposit with the gum, we will find the pericementum and alveolus in quite a normal condition.

This is the case, even when the deposit has encroached upon the alveoli almost to the apices of the roots. Even in these cases we may have a fa:tid, sanious discharge, but instead of proceeding from deep pockets it comes from the tissues in the immediate vicinity of and directly underlying the deposit. If any pockets are formed in these cases of salivary calculus they are very shallow, and the destruction of the pericementum and absorption of the alveoli show little tendency to increase any more rapidly than the ulceration and recession of the gums. In pyorrhoea alveolaris there is frequently no recession of the gums, little or no salivary calculus about the necks of the teeth, and yet we have extensive involvment of the pericementum and alveolus and usually, if not always, the presence of the dark or sanguinary variety of tartar on the roots.

We sometimes see the manifestations of these two affections, viz: salivary calculus and pyorrhoea alveolaris, on one and the same tooth. In the case of salivary calculus

proper, the deposit precedes and causes destruction of the pericementum, while in this disease some peculiar irritation of the pericementum precedes and causes calcareous deposit.

The etiology of pyorrhoea alveolaris is very obscure. Authorities are very evenly divided as to whether the causes are constitutional or local. Some regard it as a localization of a systemic debility, while others believe it to be due entirely to local causes, and amenable to local surgical treatment. Some attribute the occurrence of the disease entirely to the presence of tartar and its effects upon the surroundings of the teeth, while others say that while tartar is usually present it is only a concomitant or sequence of the affection and never the cause. Those who maintain the latter view declare that the disease sometimes occurs without the presence of any tartar.

Constitutional dyscrasia (hereditary or acquired), extreme density and low degree of vitality of the teeth, suppression of habitual secretions, catarrhal inflammation, the presence of bacteria, of foreign deposits (salivary, serumal or sanguineous), and local irritation from the use of wedges, ligatures, rubber dam, &c., have been assigned as causes.

The influence of heredity in pyorrhoea is often quite marked, the disease being transmitted through several generations. Cases have been noticed in which children born before the acquisition of the disease by the parent or parents have been exempt, while those born subsequently have developed it at quite an early age. Among the cases due to acquired constitutional predisposition may be cited those caused by mercurialization, or some peculiarity of diet, nutrition, or nervous influence.

Pyorrhoea alveolaris very frequently follows mercurial salivation. The statement has been made that pyorrhoea alveolaris never occurs except in persons who have been salivated, but this theory has not been generally accepted, and I do not believe it is founded on fact.

It is believed by many that excessive use of chloride of sodium will sometimes cause pyorrhoea alveolaris. Some

authors assert that imperfect elimination of urea is its principal constitutional antecedent.

In support of the theory that suppression of habitual secretions may aggravate or incite this affection, Dr. Rehwinkel cites the case of a young lady aged eighteen, otherwise healthy, and with no accumulation of salivary calculus, in whom the teeth became very loose, presumably from the fact that the menses had never been established. The extraction of two or three of her teeth, although they were very loose, produced violent and persistent hæmorrhage. Local treatment and hygienic measures checked the progress of the malady, and when, after some months, menstruation was established, the disease disappeared and the remaining teeth became firm. Dr. Patterson has said that he believes the disease to be of a catarrhal nature, and he also inclines to the belief that the calcular deposits are simply the result or sequence of the disease. Dr. Patterson states that in the cases he has observed he has found coexisting nasal, pharyngeal, or laryngeal catarrh (generally combined) in every instance. He believes the disease is generally caused by infection from a pre-existing catarrh of the nose or throat, but states, also, that the catarrhal condition of the mouth may originate in that cavity, and not be due to infection, or (I think he should have said) extension of the disease, at all. These primary cases, he thinks, are most apt to occur in those who are in the habit of breathing through the mouth. In support of his theory Dr. Patterson cites the following points of similarity in the pathology of the two diseases, viz:-Nasal catarrh and pyorrhoea alveolaris.

Ist. The similar appearance of the affected mucous membrane in both diseases and in the various stages of each.

2nd. The identical character of the effusions, viz: first serous, containing numerous epithelial scales, and then becoming filled with pus and blood corpuscles.

3rd. The infectious nature of both diseases, nasal

catarrh being contagious and sometimes epidemic, pyorrhoea alveolaris frequently showing a tendency to spread from one tooth to the rext, until all may be affected.

4th. The similar burrowing of pus in each trouble. 5th. The tendency in each to destruction of periosteum and underlying bone.

6th. The calcareous deposits occurring in each disease. (Deposits of phosphate and carbonate of lime are sometimes formed in cases of nasal catarrh.)

It is possible that the predisposing, or constitutional cause of pyorrhoea alveolaris may, in some instances, be a tendency to catarrhal inflammations; but I do not believe, as does Dr. Patterson, that this disease is transmitted from a pre-existing catarrh of the nose or throat. It is true we can have, according to the medical authorities, an extension of catarrhal inflammation from the nose, throat, or even from the stomach, to the mouth, and we then have acute or chronic oral catarrh, or catarrhal stomatitis; but in such cases the process is a general one, and affects not only the mucous membrane of the gums, but also that of the lips, cheeks, tongue, &c., which condition we do not have in pyorrhoea alveolaris. Dr. Patterson states that both nasal catarrh and pyorrhoea alveolaris are of an infectious nature, and further states that text-books all agree that nasal catarrh is not only contagious, but sometimes epidemic.

There may be some instances in which the disease appears to be infectious. The epidemic said to have occurred in St. Gall, Switzerland, in 1876, if the reports be authentic, would be an instance of this kind. In this epidemic the disease was said to be very severe, and investigation demonstrated the presence of numerous parasites (leptothrix, bacteria, &c.) in the secreted matter, but no pus corpuscles. Schlenker, who studied these cases, concluded that the presence of the parasites was the cause of the inflammation of the root membrane. Some observers, among them being Dr. G. V. Black, of Illinois, and Dr. Witzel, of Germany, believe that the disease is caused by a certain species of